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Thoracoscopic thoracic duct sealing with LigaSure in two children with refractory postoperative chylothorax
Karim Khelif1, Fadi Maassarani, Martine Dassonville
1Department of Pediatric Surgery, Queen Fabiola Children's University Hospital, Brussels, Belgium. karim.khelif@huderf.be
Insights
This study shows thoracoscopic thoracic duct thermofusion and section using the LigaSure device is a safe and effective treatment for persistent chylothorax in children after cardiac surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Thoracic Surgery
- Minimally Invasive Procedures
Background:
- Chylothorax is a rare but serious complication following pediatric cardiac surgery.
- Persistent chylothorax requires effective management to prevent complications like malnutrition and infection.
Observation:
- Two pediatric patients developed refractory chylothorax post-cardiac surgery.
- Conventional medical management failed to resolve the chylous drainage.
Findings:
- Thoracoscopic thoracic duct thermofusion and section using the LigaSure device was successfully performed in both cases.
- Lymph leakage ceased rapidly, with no recurrence at one-year follow-up.
Implications:
- This technique offers a simple, effective, and safe option for managing pediatric postoperative chylothorax.
- LigaSure device demonstrates utility beyond its intended vascular sealing for lymphatic procedures.
Purpose:
Chylothorax is an uncommon complication of cardiac surgery. We report two cases of the thoracoscopic management of persistent postoperative chylothorax by thoracic duct thermofusion and section with the LigaSure device.
Materials And Methods:
A 6-year-old boy and a 3-year-old girl developed persistent chylothorax following an aortic coarctation repair and a Fontan procedure, respectively. The former presented with a left chylothorax due to direct surgical injury, and the latter, a right chylothorax due to indirect lymphatic rupture secondary to increased venous pressure. In both patients, voluminous chylous drainage persisted for more than 3 weeks despite maximal medical treatment. Ultimately, a right thoracoscopic coagulation and section of the thoracic duct with the 5-mm LigaSure device was performed. The LigaSure is a computer-controlled bipolar diathermy system designed to seal blood vessels up to 7 mm in diameter, with no specific recommendations regarding the lymphatics.
Results:
The lymph leakage ceased within 2 days in the first patient and immediately in the second one, with no recurrence after oral intake resumption on day 5. Both patients are free of recurrence at 1 year.
Conclusion:
Thoracoscopic coagulation and section of the thoracic duct above the diaphragm with the LigaSure device appears to be a simple, effective, and safe therapeutic option for treatment of refractory postoperative chylothorax in children.
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